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Knowledge Management in Global Health Research Planning


C. Greiner and T. Rose
Research Institute for Applied Knowledge Processing (FAW)
Helmholtzstr. 16, 89081 Ulm, Germany
Phone ++49 731/ 501 - 950 Fax ++49 731/ 501 - 999, E-mail {greiner|rose}@faw.uni-ulm.de



Introduction

It is increasingly recognized that the efficient supply of information and expertise is of critical importance for the success of many organizations. The adequate representation, utilization, and marketing of existing experience, expertise and competence of any organizations, which can be summarized by the term knowledge management, can be viewed in this context as a prerequisite, critical success factor, and even as commodities of modern organizations and enterprises.

This papers goes even a step further by raising the hypothesis, that "an adequate knowledge management can also improves the underlying business process". To verify this hypothesis a specific organization -the World Health Organization (WHO)- with a strategic mission is investigated. However, WHO is one representative of a typical user community with distributed knowledge resources; consequently, the gained findings can be generalized and in particular, the corporate memory identification and utilization process can be transferred.

Knowledge Domains in Health Research Planning

Before presenting those knowledge domains in health research planning (viewed as a strategic decision making process) that influence its process design and that can benefit from the adequate utilization of a "corporate memory" the specific role of WHO in health research planning is described.

As an organization mandated and committed to the improvement of global health, WHO needs to encourage and call upon the world's scientists to conduct research in the field of global health, and to facilitate the dissemination and application of major research results (WHO, 1986, 1993a, and 1993b). Noting the existence of continuing problems and of emerging risks to health, the need is recognized to improve the manner by, and the extent to, which scientific resources can support the needs of public policy makers, and to facilitate and provide incentives for more systematic research efforts from the scientific and academic communities. Therefore, for the purpose of promoting a positive and ongoing dialogue between public policy makers and the scientific community, WHO must act as a research catalyst and a facilitator of discussions between these two important stakeholder groups and must assist in building research capacity at national and international levels. It is recognized that WHO serves an important function in coordination of health research and research planning, particularly if provided with efficient central scientific support in both organizational terms and with appropriate technical facilities. Therefore, it is one of the responsibility of the organization to act as a "broker" between the health development needs of the society (as voiced by governments) on the one side and expressed by the scientific community on the other.

WHO recognized these challenges and initiated the preparation of a guiding document concerning the contribution of science and technology towards the amelioration of the global situation with specific emphasis on the global health development. This document, called "Science and Technology for Global Health Development: A Research Agenda" (hereinafter referred to as the Research Agenda) is accompanied by an ongoing research planning process and an implementation methodology. Fulfilling the above tasks require an adequate knowledge management. In particular,

* population health status indicators must be identified, analyzed and the corresponding problems clearly delineated,

* population health indices (profiles) must be created and research priorities set,

* research targets must be specified, dates set, and progress measures established, and

* research activities must be initiated and health programs developed, implemented and evaluated.

The WHO network of experts encompasses several organizational units, each composed of their own experts. A significant part of WHO's work is carried out by Regional Offices, each of which supports a number of countries within a region. There are six such Regional Offices (Washington, Copenhagen, New Delhi, Brazzaville, Alexandria and Manila). This paper is mainly concerned with ACHR (Advisory Committee on Health Research). The work of the ACHR is usually carried out by discussion to make recommendations. The ACHR-system typically meet only a few times a year. Due to these long intervals, the preparation of recommendations and the processing of drafts often requires more time than acceptable and actually necessary. Lead time, which is critical for long development cycles of health programs and the high costs of advanced research programs, is lost. However, no centralized research planning approach appears feasible without appropriate regional or local support. Consideration of national and regional expertise is indispensable.

The corporate memory in health research planning

The mandate and tasks of WHO, especially, its global health research strategy planning, can be viewed as a corporate business process of a distributed organization. All kind of the activities within this process are influenced by its underlying knowledge management. The knowledge management activities can be structured in the same three broad categories that encompass managerial activities: strategic, managerial (tactical), and operational (H. Simon, 1977 and Gorry, Scott-Maorton, 1971).

* strategic: e.g. identification of global research opportunities including their implementation

* managerial: e.g. control of various health programs, such as AIDS and malaria programs

* operational: e.g. databases management concerning the health status of the world

Another, orthogonal, taxonomy of categories range from structure to content

* content: the knowledge representation of the health domain: What is health? How do specific aspects of health influence each other? Which health measures and programs are available? What knowledge is missing? Where are the priorities for interventions?

* structure: existing organizational structure (global headquarters, regional offices, system of advisory committees, external consultants, etc.) Who is doing what? Whom to ask and for what purpose? Who has which responsibilities and/or experience?

These dimensions together create the corporate memory of WHO, which is the core basis of the reputation and competence of WHO on health issues. However, the effectiveness and competitiveness of a modern organization can substantially benefit from the effective support and coordination of knowledgeable contributions by means of adequate information and communication technology for infrastructure and services.

Knowledge domains in the health research planning process

The research planning process of WHO centers around an adequate description of the health status, a detailed analysis of health deficits, the identification of priorities in health research in respect to global needs, and the transfer of this knowledge to programs that reduce these deficits. The process has two flows - one is the identification of knowledge deficits and choosing ways of reducing them, the other to apply new knowledge to on- going programs (or by creating new programs). At the same time the way targets are reached can vary depending on the region, groups of researchers, and earlier outcomes. In the following we describe these elements in some more detail. However, we restrict ourselves to the strategic dimension from the content point of view in this section (see 2.1.):

* Visualization of the knowledge domains (global health profile): In order to adequately record the health status, there is the need to identify major reliable parameters describing the health status based on the latest available data and information. Based on the identification of relevant information servers, background information retrieval, previous work of WHO, and by expert hearings a selection of most significant indicators describing the health status is achieved.

* Analysis of knowledge domains (global health analysis): The next step is a differentiated analysis of the health status in order to identify potential areas for health research. Input for this analysis is a classification scheme developed in earlier WHO studies and an adequate visualization of the problem landscape. This analysis includes a structuring of causes, among others, along the following guideline: knowledge deficit, information deficit, and application deficit.

* Assessment of the knowledge domains (evaluation of health deficits): In order to find priorities for health research, the health deficits have to be evaluated and even ranked. Whereby, the importance of criteria used in this process and the resulting priorities may vary from region to region. An incomplete list of criteria for selecting priorities include the prospect for success and impact of success, the desired health care outcome: primary, secondary, tertiary prevention, the time-frame: long, medium, or short term, research type and alternative intervention options, cost benefit analysis, etc.

* Utilization of knowledge (implementation of research projects): All this finally leads to project proposals. The implementation of research activities and the transfer, application, and utilization of research results and programs hopefully improves the future health status. Monitoring the success of implemented measures closes this kind of a feedback loop for another cycle, beginning again with description of the health status.

The types of knowledge dealt with in the research planning process of WHO range from rather descriptive to more explanatory and evaluation-oriented aspects, but cover also knowledge concerning the quality, representation, utilization, acquisition, and dissemination aspects of these knowledge domains (in the following referred to as meta-knowledge). In particular, the tackled knowledge domains can be structured as follows:

* description of the status quo: knowledge mainly based on statistical data e.g. mortality data;

* explanation of status quo: knowledge describing the relationship and linkages between elements and factors that inform about the status quo, e.g. (mathematical) models;

* application and utilization of existing knowledge: knowledge concerning measures that could change (improve) the status, e.g. vaccine programs;

* identification of knowledge gaps: knowledge on what we do not know (meta-knowledge), e.g. the research agenda;

* generating of new knowledge: development of knowledge to implement new measures, e.g. research and development for a new vaccine.

It is worth noting that all these knowledge domains have not only a static dimension, but are very dynamic. For instance, the health status of a region constantly changes over time, which results in the necessity to permanent update the status quo description, with further impact on measures to improve the health status and on the identification of those knowledge gaps, if appropriate measures are not yet available.

The Impact of the Knowledge Domains on Process Design

Process specifications

Chapter 2 started with the mission of WHO or more abstract the strategic goal of an organization, continued with the identification of the key elements in order to achieve the strategic goals, and ended with an analysis of the involved knowledge management processes. In brief, only the knowledge management aspects concerning the "product" (content of the research agenda) were tackled. This analysis did not incorporate the organizational structure and the involved human competence, which is also a sort of know-how, and therefore, it does not reflect the specific value or quality which is added to the "product" due to the various contributions of the "knowledge providers". Also the impact of the process design on the quality of the "product" is neglected.

Although most organizations are hierarchical, many strategic decisions are made by groups (group decision making). This is a rather time consuming process, especially, because of the high communication demands between members of the group. The resulting group decisions rely among others on the composition of the group, the knowledge, opinion and judgment of its participants, the decision making process used by the group, and the group dynamics.

The essential element of decision making in groups is to reach consensus concerning the decision (or identified solution) which later reduces the likelihood resistance against measures that will be taken during the implementation phase (need for consensus). Facilitators or moderators are often required to support strategic planning processes in order to increase the quality of the result and to speed up the process, since it is required to attain simultaneously objectives that might conflict with each other (multiple goals). Therefore, an adequate presentation (e.g. visualization) of those goals for comparability and assessments purposes is requested. This is especially true, since strategic planning activities are normally conducted by high level executives, and not by specialists. Thus, a knowledge representation for non-expert usage (i.e. simple, understandable, objective, standardizable) is essential.

Knowledge Management

To make the better use of the expertise and competence of an acting network, often requires to increase its efficiency. This can be attained by:

* an improved support of the collaborating tasks of the network,

* a better design of the collaborative tasks.

Both necessitate improved knowledge management. This includes, especially :

* an easy-to-use access to relevant knowledge by members of the network,

* more than satisfactory notification schemes concerning news in the corporate memory of the organization,

* the adequate structuring of the knowledge domains, and

* and the adequate acquisition and dissemination of knowledge to all interested network participants.

Moreover, an improved knowledge management has an impact on the collaboration of a network and on their "product".

Utilization of the corporate memory: INTERNET based knowledge access, dissemination, and acquisition

It is becoming clear that the dire nature and extreme urgency of many global health problems represent mounting threats to global health and world stability, and therefore warrant serious attention by all who are in a position to effect positive changes. In this respect, the Research Agenda is essentially a call to arms to the members and representatives of the global science and technology community, and offers a plan according to which effective and efficient solutions to global health problems can be sought (Fliedner et al, 1995 and 1996). This initiative was designed to provide a transparent research planning and review process with which to solicit and foster the research which will be required to guide and support subsequent remedial and evaluative action.

In order to provide some degree of guidance as to the relative urgency and potential impact of respective solutions, WHO has been proposing to establish a process of identifying and assessing extant research issues so that a continuously updated list of the most critical research targets, referred to herein as research imperatives, can be provided by WHO as a research guide. (This research planning process is based on the methodology suggested by Carrese and. Baker, 1967). The research issues identified as of particular relevance and importance at any point in time is, in other words, represent a 'shopping list' from which the world's scientists, research funders, and decision-makers are urged to make a selection for their research and development activities.

To be both effective and efficient, the design, conduct and application of such research must be based on new (and global) forms of cooperation and collaboration among researchers and those involved in health-related policy- and decision-making. In today's environment, this is not possible without the utilization of advanced information and communication technologies (ICT) (Greiner et al 1996). For this reason, WHO has started to identify and publicize the above-mentioned global research imperatives, but will also provide and maintain a facilitating mechanism with which they can be most effectively addressed. (A prototype hereof will be described in the next sections.) This mechanism consists of the creation of, and support for, ICT-based networks linking collaborating scientists and other partners in a research-oriented assault on global health problem areas. WHO's vision is that of a network of networks, including problem-, discipline, and training-oriented networks, all of which will have as their prime objective the identification, analysis and solution of global health problems. Some will have as their mandate the creation of a new research paradigm as the armament for science to cope with emergent problems of a global nature.

As described earlier, the proper utilization of the corporate memory of such working units (networks) and an adequate knowledge management within the goal-oriented collaboration are essential. In the following, INTERNET based knowledge management examples for some of the key knowledge management domains in health research planning of WHO are presented.

Access to the corporate memory

In the case of global planning the WWW offered the best attraction, because of its wide availability. A discussion database was also deemed to be essential and this was provided through special interactive pages developed for the WWW site. As a final design step, selected services are integrated into a platform (Schmidt and Rodden, 1992). This provides an interface that allow users to easily select services and move easily between them. Usually this means that, because of technical constraints on seamlessness, a minimum set of services is used.

Figure 1: The Planet HERES home page, with a set of services allowing to utilize the corporate memory of WHO for global health research planning purposes on the left. In particular, this page shows the so-called contact map, which offers information concerning the experts involved in the research planning process (specific background, and expertise, contact information, etc.).

Our first step was to develop a demonstrator system based on the WWW to provide a platform for such services. This is illustrated in Figure 1 and is accessible via http://www.faw.uni-ulm.de/planet. The site provides both public services as well as those intended for restricted use only by members of the WHO. The top menu for example, includes contact points, access to publications as well as the overview of the operation of health planning. Selection of `login to Service' brings up the menu shown on the left and is accessible only to people through password control.

In more detail, the WWW interface to Planet HERES (Planning Network for Health Research) provides support for basic services like, access to relevant databases, information of involved experts, a mailing list for general announcements. These services are designed to utilize the structural dimension of the corporate memory.

On the product or content dimension of the corporate memory, services for the analysis of the status quo of the global health situation (see 4.2) and for a moderated discussion forum to generate the research agenda (see 4.3) are provided.

The HEALTH PROFILE

A visual presentation of data describing or representing the health and well-being of a given population in an holistic manner must include disease associated information as well as information describing causal and contributing factors to disease conditions and health impairments, such as social, political, economic and environmental dimensions of a community1. The chosen approach, the "Visual Health Information Profile" (Beyrer, Greiner, et al, 1997 and http://www.faw.uni-ulm.de/planet/healthnet/circle.html) consists of a disc shape.

The indicators are grouped into five sectors called "domains". Each domain is devided into various smaller sectors which represent specific indicators radiating out from the center. Each of these sectors are scaled linearly from 1 to 10 beginning at the periphery and progressing towards the center. Each indicator value is plotted onto "its own" sector on the disc after receiving a relative rating between 1 and 10 using the decile rank ordering procedure described below. Indicators receiving low relative scores will be represented by sectors projecting out towards the periphery of the disc, while measurables with high relative scores will be located closer to the center of the disc. Projecting all of the indicators onto the disc yields a pattern, or profile, highlighting the relative differences between the applied indicators. This "strengths" and "deficits" are visually easily identified. For an example see figure 2.

A hierarchical approach is used in the Visual Health Information Profile which groups the health parameters into five domains. These include: 1) Disease Conditions and Health Impairments, 2) Health Care System, 3) Socio-Cultural Characteristics, 4) Environmental Determinants, and 5) Food and Nutrition2,3. While the indicators represent the components generating the top level of the health profile, each indicator can be broken down further if sufficient detailed statistical or epidemiological data are available. Thus it is possible to always analyze a selected health indicator by disaggregating a given value down to its origin or to the actual problem level. This feature allows incorporating both aggregated and disaggregated data into the Visual Health Information Profile without losing essential information. The structure of the data base used in generating this health profile thus presents to the user with a very high degree of transparency.

Figure 2: Visual Health Information Profile for Mexico. Five domains including 32 indicators are shown. The relative score of "1" is located at the periphery and the score of "10" is located at the center. "Deficits" are seen for indicators projecting out towards the periphery. Major deficits are seen in four domains.

The RESEARCH AGENDA

The Research Agenda outlines a framework of concepts and methods according to which individual members and representatives of the global science and technology community can be enlisted and coordinated in systematic and ongoing research initiatives targeted on making significant improvements in the global health situation.

The major planning support in order to develop the research agenda that can be selected as one of the login services is a moderated research agenda discussion forum. As shown in Figure 3 it provides the current listing of issues that have been raised in the agenda. The discussion forum shows the general outline (similar to the table of content of a book) of the research agenda, as developed in previous meetings, discussions and questionnaires, which represents the actual status of the on-going discussion.

Since each topic in this agenda should be further discussed an easy to use interface was developed. Users can make contributions by entering a particular issue (by clicking on it). Then user will receive an overview of the contributions of the other participants as well as it will give easy access to enter new recommendations or comments.


Figure 3: Moderated Research Agenda


Discussion and lessons learned

The development of an INTERNET based information system to support the various phases of research planning activities of WHO showed that a proper identification of existing experiences, competence (knowledge) is essential. The developed methods to deal with the involved knowledge domains have proven their validity. In particular, 1.) the health profile as presentation schema for statistical data, that can be combined with hierarchical structuring hereof and 2.) the research agenda as a example more explanatory information for the development of a strategic goal within a organization can be viewed as key elements for the management of knowledge concerning the content or product of a organization. Quality can not only be added to the product by the adequate support of those content oriented knowledge management technologies, but also be making full use of the existing structure and competence of the organization. In this respect, services like the described contact-map (easy access to structural knowledge of a organization) have their specific potential. Especially, due to the parallel design of the research planning process, development of content and structure oriented services, and finally, the identification of research imperatives, it was possible to monitor at different development stages the impact of the utilization of corporate memory on the "process" and on the "product". It came apparent, that knowledge management is on of the key elements for successful business processes. In this respect, as a example the adequate utilization of the human resources is mentioned.

The application potential of the presented approach lies in the various generic representation schemes of "knowledge". This structural information can be used to develop powerful filters and brokers for any application domain be it in industry or administration. The planning process, a electronically supported, modified Delphi technique, can also be transferred to other situation, especially in the identification of strategic goals within organizations or enterprises.

In conclusion, the example of health research planning shows that the intensive communication needs can be supported by the utilization of currently available information and communication technology. An adequate knowledge representation of the corporate memory is essential. Thus, existing processes can be made to work more effectively by identifying deficits and transferring knowledge in shorter time frames and to deliver qualitatively, vastly improved products.

References

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